Ostéomyélite de l’apophyse odontoïde : intérêt de la TEP/TDM au 18F-FDG dans le bilan d’extension infectieux à distance

Odontoid process is an atypical and very rare localization of osteomyelitis. We reported the case of a 72-year-old hemodialysed man with methicillin-sensitive Staphylococcus aureus osteomyelitis of the odontoid process. Osteomyelitis was diagnosed at MRI and ¹⁸F-FDG PET/CT. While clinical examination and conventional radiographs were non contributive, ¹⁸F-FDG PET/CT also allowed the diagnosis of right foot osteomylitis and multiple vertebral septic localizations. ¹⁸F-FDG PET/CT done at month 3 demonstrated a regression of the odontoid and foot hypermetabolic activity. This case illustrates the atypical presentation of this septic localization and the usefulness of ¹⁸F-FDG PET/CT to perform whole body screening and detect septic metastasis.     

Osteomyelitis of the rib cage by Aspergillus flavus

BackgroundAspergillus osteomyelitis of the ribs is relatively uncommon. It is a debilitating and severe form of invasive aspergillosis.Case reportA 61year-old female presented with spontaneous chest pain on the right side of the rib cage and a palpable soft-tissue mass. FDG-PET/CT scan identified activity in the infected site. The lesion was punctured, and purulent material was sent to the laboratory. Aspergillus complex Flavi was isolated. An antifungal treatment with voriconazole was started. The lesion healed, and no recurrence was observed at 8-month follow-up. Molecular identification of the isolate was based on PCR amplification and sequencing of β-tubulin gene. Aspergillus flavus was identified.ConclusionsOur case highlights the relevance of microbiological studies in patients with osteomyelitis and the involvement of soft tissue. The FDG-PET/CT scan was found to be a useful tool for revealing the extent of the disease and evaluating the response to the antifungal therapy.     

外固定架联合抗感染活性骨治疗下肢创伤性骨髓炎

目的:验证外固定架联合抗感染活性骨(ARBX)治疗下肢创伤性骨髓炎的疗效。方法:25例下肢创伤性骨髓炎患者给予原内固定取出、病灶清除、断端修整、抗感染活性骨植骨、外固定架固定,通过长期随访,分析评价其疗效。结果:随访2-10年,平均6年,感染彻底控制无复发23例,感染治愈率92%;骨不连、骨缺损获得骨性愈合24例,1例残留骨不连,愈合时间6-24月,骨性愈合率96%。结论:外固定架联合抗感染活性骨是治疗下肢创伤性骨髓炎的安全有效手术方法。     

Staphylococcus epidermidis serine–aspartate repeat protein G (SdrG) binds to osteoblast integrin alpha V beta 3

Staphylococcus epidermidis is the leading etiologic agent of orthopaedic implant infection. Contamination of the implanted device during insertion allows bacteria gain entry into the sterile bone environment leading to condition known as osteomyelitis. Osteomyelitis is characterised by weakened bones associated with progressive bone loss. The mechanism through which S. epidermidis interacts with bone cells to cause osteomyelitis is poorly understood. We demonstrate here that S. epidermidis can bind to osteoblasts in the absence of matrix proteins. S. epidermidis strains lacking the cell wall protein SdrG had a significantly reduced ability to bind to osteoblasts. Consistent with this, expression of SdrG in Lactococcus lactis resulted in significantly increased binding to the osteoblasts. Protein analysis identified that SdrG contains a potential integrin recognition motif. αVβ3 is a major integrin expressed on osteoblasts and typically recognises RGD motifs in its ligands. Our results demonstrate that S. epidermidis binds to recombinant purified αVβ3, and that a mutant lacking SdrG failed to bind. Blocking αVβ3 on osteoblasts significantly reduced binding to S. epidermidis. These studies are the first to identify a mechanism through which S. epidermidis binds to osteoblasts and potentially offers a mechanism through which implant infection caused by S. epidermidis leads to osteomyelitis.     

改良Papineau植骨术与抗生素磷酸钙骨水泥局部应用治疗牵张成骨并发Ceirny III型骨髓炎的比较研究

摘要 目的：探讨改良Papineau植骨术与抗生素磷酸钙骨水泥局部填塞治疗牵张成骨技术使用中并发Ceirny III型骨髓炎的疗效。方法：回顾性分析自2013年1月到2015年4月采用改良Papineau植骨术与抗生素磷酸钙骨水泥局部填塞治疗牵张成骨技术并发Ceirny III型骨髓炎17例。A组6例,采用清创后磷酸钙骨水泥5 mL混合0.5 g万古霉素粉剂清创后填塞治疗。B组11例,采用改良Papineau植骨术,即清创后,按5 mL体积松质骨混合0.5 g万古霉素粉剂,清创后植入缺损部位。两组病例术后均行封闭负压吸引(VAC)治疗7天。随访病人局部疼痛缓解情况,皮肤红肿表现、窦道愈合情况、骨缺损部位骨愈合情况以及术后复发情况来判定疗效并比较分析。结果：17例病人术后随访12~20个月。A组全部病例术后2~3周局部炎症消退,创口愈合,定期检测血白细胞计数（WBC）、血沉（ESR）和C反应蛋白（CRP）均下降至正常,2例再未出现感染征象,4例病人于术后3 ~10周再次出现渗液,局部皮肤发红,ESR、CRP进行性升高表现。再次给与清创,换药治疗后逐渐愈合,随访再无渗液出现。B组病人11例,创口2~3周内全部愈合,定期检测WBC、ESR和CRP均下降至正常。随访未见复发。结论：抗生素负荷磷酸钙骨水泥在牵张成骨技术治疗后并发Ceirny III型骨髓炎时,虽有效果,但复发率较高,改良Papineau植骨术疗效更好。     

Natural variation and differential diagnosis of skeletal changes in tuberculosis

Twenty-six documented cases (17 blacks, 9 whites) of skeletal tuberculosis from the Hamann-Todd Osteological Collection, Cleveland Museum of Natural History, were analyzed for lesion variability and patterns of multiple site involvement. In addition, several documented cases of pathologic conditions (osteomyelitis, vertebral fractures, and malignant bone tumors) that resemble skeletal tuberculosis were photographed and described for use in differential diagnosis. The range of variation of tuberculous lesions was found to be considerable. Thirty-eight percent (10/26) of the cases display skeletal lesions in two or more regions concomitantly. The average number of vertebrae affected, as well as the incidence of multiple bone involvement, were found to be higher in blacks. Certain combinations of skeletal lesions (e. g., spine-rib, spine-rib-sternum, and spine-hip) may be useful in the diagnosis of tuberculosis in dry bone material.     

Use of technetium antigranulocyte monoclonal antibody Fab' fragments for the detection of osteomyelitis

Accurate early diagnosis of osteomyelitis is critical for optimal clinical management. Conventional radiology (X-rays, CT) and nuclear medicine scans (bone, gallium, and technetium/indium white blood cell [WBC]) have limitations and drawbacks. The monoclonal antibody (MAb) ImmuRAID^TM-MN3 (Immunomedics Inc., Morris Plains, NJ), a 99m-Tc Antigranulocyte Fab' fragment, recognizes a surface glycoprotein NCA-90/95 shared by granulocytes, carcino-embryonic antigen (CEA), and meconium antigen (MA). Intravenous injection of radiolabeled MAb enables in vivo labeling of human granulocytes and targets infected lesions in the bone and throughout the body. Technetium labeled Fab' fragments rapidly clear the blood pool and high-quality images can be obtained the same day, as early as 1 h postinjection. Results at our institution on 13 patients with clinically suspected osteomyelitis of infected long bones, prostheses, and diabetic foot ulcers were compared with the surgical/bacteriological verification of the presence or absence of infection. The MAb scan showed six true positives, six true negatives, and one false negative (very low grade infection). The procedure was safe, no clinical or laboratory adverse reactions were encountered. The MAb fragments are markedly less immunogenic than whole IgG, resulting in lower induction of human antimouse antibody (HAMA) titers. No HAMA to this MAb fragment has been detected in 24 patients (data from multiple institutions). Our preliminary results suggest that 99m-Tc ImmuRAID^TM-MN3 is highly accurate for detection of osteomyelitis. This study is part of an on-going multiinstitutional project sponsored by Immunomedics, Inc. to evaluate the efficacy and safety of this radiopharmaceutical.     

DEXA对骨髓炎骨缺损治疗中骨痂密度的评价

目的：探讨DEXA对骨髓炎骨缺损治疗中骨痂密度的评价及意义。方法：严格按照纳入排除标准,选取21例骨髓炎清创后伴大段皮质骨缺损一期植骨的病人。术后4,6,8,10个月后对骨折端骨痂行双能X线骨密度仪检测,并进行X摄片以及Enneking评分,从而明确植骨区愈合骨痂的密度变化趋势,骨愈合情况以及症状改善情况。结果：（1）X线摄片结果显示：4个月后：骨缺损区依然清晰可见,内有少量稀疏骨痂通过,少量外骨痂形成。6个月后：植骨区内骨痂含量明显增多,且外骨痂膨大。8个月：缺损区模糊,有较致密骨痂生成,且外骨痂逐渐减少。10个月：植骨区骨痂更加致密,且部份髓腔再通。（2）Enneking评分：患者术后第10个月功能恢复情况评估正常功能20例,20分以下的患者1例。（3）BMD测定：骨折端的骨密度及骨密度比率随时间延长而增加,植骨10个月后患侧的骨密度已可基本上达到正常对照侧的骨密度水平。结论：双能X线骨密度测量从一定程度上反映出骨痂的力学强度特性。在感染性骨缺损治疗中可以作为检测植骨区的恢复情况的参考。     

Osteological evidence for smallpox: a possible case from seventeenth century Ontario

Identification of possible osteomyelitis variolosa in a Neutral Indian cemetery dated to just before A.D. 1650 provides the first recognition of smallpox in an archaeological context. The radiological literature is reviewed to support the identification. The ethnohistorical literature is at odds with the evidence presented and the historical background is briefly discussed, together with the ambiguities and contradictions in both primary and secondary sources.